How do you know when you are in the right type of treatment?
Deciding on the appropriate level of care for your loved one can be a daunting task. Because of the complexities of eating disorders the type and level of care needed is not the same for everyone. The first step in deciding the level of care most appropriate for your loved one begins with an evaluation by his or her primary care physician. Your loved one’s medical stability will be a major factor in determining the type of treatment appropriate for his or her situation. We do have a strong belief that recovery happens at home so the more that can be done at home safely and effectively the better.
Inpatient or Residential Care
This level of care requires your loved one live at the treatment facility. Patients are monitored by trained staff to prevent eating disorder behaviors and to monitor for medical complications. This is a good option for people who have not been able to abstain from eating disorder behaviors and need the level of accountability that a 24/7 treatment facility offers. In addition, this is a good treatment option for those who have medical complications related to their eating disorder that require closer medical monitoring or management. Inpatient programs are a better choice in your loved one’s medical condition is severe or poses a significant risk to their health. In essence the treatment staff assumes the role of your loved one’s support team and passes that to you when he or she is discharged to a lower level of care.
A sign of a good residential or inpatient program is intensive family involvement. While your loved one is at this level of care the facility should be taking the opportunity to support you in learning how to support your loved one’s recovery once he or she returns home. Some questions to ask the staff include:
· What type of support will the family receive?
· How will I learn to support my loved one’s recovery one he or she is home?
· What sort of support do you get in setting up your loved one’s outpatient treatment team?
The downside of this level of care is that your loved one is living away from home and has to take time away from work or school to get treatment. For some people this level of care is not offered close to where they live so they have to travel a considerable distance to receive treatment. Having to travel to receive care can interfere with their support team being actively involved in their treatment. It can be difficult for some on your support team to be physically present during treatment to learn how to support you during or after meals. Nevertheless, if you have not been able to abstain from your eating disorder behavior outside this level of care or you need more active medical monitoring residential or inpatient care may be your best option.
Partial Hospitalization Programs
Partial Hospitalization Programs (PHP) are typically 8-12 hours of treatment 5-7 days per week. Patients participating in a PHP receive intensive treatment throughout the day but then go home at night. The benefit of this level of care is that loved one gets to go home at night and practice those things he or she learned in treatment. In addition the support team has an opportunity to practice helping your loved one abstain from eating disorder behaviors outside of a treatment setting. The problem with this level of care is if the support team is not ready to support the patient’s abstinence from eating disorder behaviors being away from treatment in the evenings and overnight may be too much independence for some patients. It’s important to remember that the level of care most appropriate for your loved one is largely based on him or her abstaining from eating disorder behavior. The combination of treatment and support from the support team that enables your loved not to engage in eating disorder behavior is the level of care most appropriate if medical stability is achieved. If that can be accomplished at home, the better.
Intensive Outpatient Programs
Intensive Outpatient Programs (IOP) are typically 3 hours of treatment per day 3-5 days per week. The benefit of an IOP is for patients needing multiple services (education groups, psychotherapy, family therapy, dietary services) they can receive from a collaborative team all in one place. Outside of an IOP patients would need to travel to the different offices of the providers to receive services and collaboration between providers sometimes can be problematic. This is largely due to the fact that providers practice is different locations whereas in an IOP and most other structured treatment program all the providers work at the same location.
Most IOP’s are in the evening so if patients work during the day or go to school they likely can continue to do so while receiving treatment. Many IOP’s are group focused. This can be a positive experience for some in that they can feel additional support from peers. However, for others it can be an environment where they learn about additional eating disorder behaviors.
All of the above levels of care are time limited. Your loved one typically does not stay at the facility until recovery is achieved. Instead, length of stay is typically determined by assessment that he or she can continue in recovery at a lower level of care. Families and support teams should not expect their loved one’s to be recovered once treatment at any of the above levels of care is complete. Treatment to recovery happens at the outpatient level of care.
Family Based Treatment
Family Based Treatment for Anorexia and Bulimia
Family based treatment (FBT) is a treatment option for children and adolescents with a diagnosed eating disorder and who are living at home with their family (Eating Disorders Victoria, 2014). It is currently the leading treatment for adolescents with eating disorders and is often used as the first approach when treating any eating disorder (Rienecke & Le Grange, 2022). FBT is an evidence-based treatment, meaning that it has been tested and judged to see if it would be affective and appropriate for a given population. It was developed by Christopher Dare and Ivan Eisler, two family therapists, in the late 1970s and early 1980s in London, England(Loeb and Le Grange, 2009). This team was based at the Institute of Psychiatry and the Maudsley Hospital in London and can also be known as the “Maudsley Approach” or “Maudsley Method” (Loeb and Le Grange, 2009). The treatment was not brought over to the United States until 1994 where it was introduced as Stanford University by Daniel Le Grange (Loeb and Le Grange, 2009).
FBT emphasizes using parents as the main recourse to bring about recovery in their child by encouraging them to have power over mealtime (Loeb and Le Grange, 2009). FBT is most notably used with children and adolescents who have anorexia nervosa (AN) (Rienecke & Le Grange, 2022). AN is an eating disorder that is classified as a psychiatric disease that involved patients restricting their food intake in many ways which involve nutritional deficiencies (Moore, 2023). While a lot of research on FBT has been done with AN patients, it has been found to be helpful in treatment for bulimia nervosa (BN) patients as well (Rienecke & Le Grange, 2022). BN is also a psychiatric disorder classified by binge eating and inappropriate compensatory behavior that can lead to potential critical complications in relation to control weight loss and nutritional deficiencies (Jain and Yilanli, 2023). Both disorders show disturbances in attitudes and perceptions in regard to weight and shape (Berrettini, 2004).
Regardless of the disorder, FBT consist of three phases that can then be shaped for the specific disorder (Rienecke & Le Grange, 2022). The first phase is parents are given the responsibility for bringing weight restoration (returning to a healthier body weight) in AN and eliminating binge eating/purging while establishing regular eating habits for those with BN (Rienecke & Le Grange, 2022). For this phase, parents are asked to make all eating-related decisions for their child while also limiting their physical activity until the eating disorder behaviors are no longer influencing the child (Rienecke & Le Grange, 2022). When transitioning to phase 2, responsibility of eating gradually gets shifted back to the child or adolescent, this is in terms of whatever the family views as being appropriate food responsibility for their age (Rienecke & Le Grange, 2022). Lastly, phase 3 involves a review of the adolescent and an assessment of there they are in their development once the eating disorder has receded (Rienecke & Le Grange, 2022). This phase can only occur when they therapist and parent become convinced that the eating and weight disturbances and other behavioral issues are no longer the focus of conversation (Rienecke & Le Grange, 2022). FBT has been found to have a success rate of 86%, meaning that patients have seen successful recovery once out of the program (Loeb and Le Grange, 2009).
Do Your Research
Deciding on a treatment environment is a tough decision being made at times emotions are often running high. Try to do as much research as you can and trust your gut.
Ways of Promoting Healthly Body Image
What is body positivity? It’s a movement that encourages everyone to love their own bodies regardless of how they appear. It’s also believing that all bodies deserve to be loved and being able to love yourself even if you think there are flaws. Body positivity goes hand and hand with self-esteem. Self-esteem is how you feel about yourself and how you view your self-worth, or your self-identified value. To be on the journey of having body-positivity for yourself you need to take a look at your self-esteem. Giving yourself the opportunity to love your body for keeping yourself healthy and building upon your self-esteem which helps you feel comfortable in
your own skin. While this is not an easy journey, and this can fluctuate throughout your life, there is a specific population that is having a very tough time with body image: teenagers. Teenagers have the struggle of going through puberty, gaining more responsibility, and
starting their journey into young adulthood. With all these factors, they can also put added pressure on themselves, feeling worthless, and feeling embarrassed about their appearances.
So, what can a parent do to help with this problem? There are a few things you can start practicing promoting healthy conversations about body image not only for your teenager but for yourself too! First is to practice self-compassion. We all get frustrated with ourselves or compare ourselves to others making us feel bad about our appearance. When we practice self-compassion, we start to learn how important and amazing our bodies truly are. Our bodies not only help us navigate the world around us but help us react to it. It helps us smile when we see a cute animal, laugh hard when hearing a funny joke, and dance when we feel happy. By showing compassion toward oneself can lead to the second part, positive self-talk.
We can now see how our bodies laugh, smile, and create happy moments for ourselves, but now we need to start showing it some appreciation. This step would be for the parents to do positive self-talk to show being a body positive role-model around their teenager. This goes into talking about your strengths about yourself and moves away from solely focusing on appearance.
What does it mean to have positive body image self-talks but not talk about appearance? We do this by encouraging positive self-talk about things other things like being smart, funny, caring, or athletic. Showing that you are loving yourself because you did a good job at work, had fun with the family, told a funny joke, or were able to go on a hike. This is to boost your own confidence
and to let your teen know it’s ok to lift themselves up and be proud of an achievement no matter the size.
Lastly, and this cannot be emphasized enough, when we do talk about appearances because it’s bound to happen, we want to speak positively. So, pointing out something about your teens body is a no! Sometimes, a comment that you may think is harmless is hard for them to hear, and something they now want to change. So instead, focus on their strengths that don’t involve their appearance. Take this within every day uses, sometimes for events or special occasions, a nice “you look [beautiful, handsome, pretty, etc]” can mean a lot too. Mainly we want to promote that all bodies are beautiful, all bodies help us in the best way they can to keep us alive and well. While we can discuss how media makes body standards, at times, impossible to reach, we go back to our previous steps to emphasize how, yes, our body may not look like that, but our body is beautiful and helps us do so many things that we don’t even notice. Our
body helps us be the people we are, stop and thank it every once in a while!
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